NHS Child Registration – Montreal Dental Care

Child Registration Form for NHS Dental Care

Please complete the form below to register a child under the age of 18 for NHS dental care with Montreal Dental Care.

Title *

Date of birth *

First name *

Surname *

NHS number (if known)

Full address *

Mobile number *

I consent to receiving appointment reminders by SMS.

Email address *

I consent to receiving appointment reminders by email.

Name of parent or guardian *

Name of school *

Social Worker Information

Does the child have a social worker? *

NoYes

If yes, please provide the name of the social worker

Name of person completing this form *

Patient Agreement

Please read the following information carefully before submitting this registration form.

I understand that a parent or guardian will need to attend all appointments with any child under the age of 16.

A minimum of 24 hours' notice must be given to rearrange or cancel any appointments.

I understand that if 2 or more appointments are missed or cancelled at short notice, it may result in my child's name being removed from the NHS list.

I have read and understood the above Patient Agreement.

What happens next: The practice will contact you within 24–48 hours of receiving this registration form.

We will use the information you provide to process this registration and contact you regarding the child's dental care. Please see our Privacy Policy for information about how Montreal Dental Care uses and protects personal information.

I confirm that I have read and understood the Privacy Policy.

Child Registration Form for NHS Dental Care

Social Worker Information

Patient Agreement

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